Department of Urology, Institute of Urology, Center of Biomedical Big Data and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan Province, People's Republic of China.
Int J Surg. 2024 May 1;110(5):3008-3020. doi: 10.1097/JS9.0000000000001164.
To conduct a meta-analysis to provide the latest evidence of nonsurgical local salvage options in the first-line radiotherapy (RT) failure setting for localized prostate cancer patients.
Recurrence of localized prostate cancer after primary RT remains a clinical challenge. There is no consensus on optimal nonsurgical local salvage therapies, which mainly consist of cryotherapy (CRYO), high-intensity focused ultrasound (HIFU), high/low-dose-rate brachytherapy (HDR/LDR), and stereotactic body radiotherapy (SBRT).
Our study was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The authors systematically searched PubMed, Web of Science, Cochrane Library, and ClinicalTrials.gov up to September 2023 to identify potentially relevant studies. The risk of bias was assessed using the European Association of Urology (EAU) items. Biochemical recurrence-free survival (bRFS) and genitourinary/gastrointestinal toxicities were the outcomes of interest. Pooled rates with 95% CIs were evaluated.
A total of 99 studies comprising 8440 patients were included. The pooled rate of 1-year biochemical control (BC) was highest for LDR (0.88, 95% CI: 0.72-0.95) and lowest for SBRT (0.68, 95% CI: 0.49-0.83). The pooled rate of 5-year BC was highest for CRYO (0.52, 95% CI: 0.33-0.69) and lowest for HDR (0.23, 95% CI: 0.08-0.51). HIFU presented the worst outcome of grade ≥3 genitourinary toxicities (GU3), with a rate of 0.22 (95% CI: 0.12-0.3). Conversely, CRYO (0.09, 95% CI: 0.04-0.14), HDR (0.05, 95% CI: 0.02-0.07), LDR (0.10, 95% CI: 0.06-0.14), and SBRT (0.06, 95% CI: 0.03-0.09) presented low rates of GU3. All subgroups induced a quite low incidence of grade ≥3 gastrointestinal toxicities (GI3).
Nonsurgical salvage therapies are promising modalities for prostate cancer in the local radiorecurrence setting. Based on the preliminary evidence from this study, CRYO and SBRT might present a relatively steady efficacy of BC with acceptable treatment-related toxicities.
进行荟萃分析，为局限性前列腺癌患者一线放疗（RT）失败后局部非手术挽救选择提供最新证据。
原发 RT 后局限性前列腺癌复发仍然是一个临床挑战。对于最佳的非手术局部挽救疗法尚未达成共识，主要包括冷冻疗法（CRYO）、高强度聚焦超声（HIFU）、高/低剂量率近距离放射治疗（HDR/LDR）和立体定向体放射治疗（SBRT）。
本研究遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南进行。作者系统地检索了 PubMed、Web of Science、 Cochrane 图书馆和 ClinicalTrials.gov，截至 2023 年 9 月，以确定潜在的相关研究。使用欧洲泌尿外科学会（EAU）标准评估偏倚风险。无生化复发生存（bRFS）和泌尿生殖/胃肠道毒性是关注的结局。使用 95%置信区间（CI）评估汇总率。
共纳入 99 项研究，包含 8440 例患者。LDR 的 1 年生化控制（BC）的汇总率最高（0.88，95%CI：0.72-0.95），SBRT 的最低（0.68，95%CI：0.49-0.83）。CRYO 的 5 年 BC 汇总率最高（0.52，95%CI：0.33-0.69），HDR 的最低（0.23，95%CI：0.08-0.51）。HIFU 出现了最严重的 3 级以上泌尿生殖毒性（GU3）后果，发生率为 0.22（95%CI：0.12-0.3）。相反，CRYO（0.09，95%CI：0.04-0.14）、HDR（0.05，95%CI：0.02-0.07）、LDR（0.10，95%CI：0.06-0.14）和 SBRT（0.06，95%CI：0.03-0.09）的 GU3 发生率较低。所有亚组的 3 级以上胃肠道毒性（GI3）发生率都较低。
非手术挽救疗法是局限性前列腺癌在局部放射复发情况下的有前途的治疗选择。基于本研究的初步证据，CRYO 和 SBRT 可能具有相对稳定的 BC 疗效，同时具有可接受的治疗相关毒性。
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